"In addition to news about discounted pricing for fertility medications, it stated that regulators would soon issue new rules making it easier for employers to offer financial support for fertility treatment as a standalone benefit. For employers that don't already provide coverage for fertility treatment through their medical plans and believe such coverage is out of reach, the rules may make it easier to provide limited support."  MORE >>

"As 2025 begins to wind down, employers in seven states -- Colorado, Delaware, Maine, Maryland, Minnesota, Vermont, and Washington -- face new compliance obligations due to recently enacted, amended, or soon-to-be-effective family and medical leave laws."  MORE >>

"[T]he Medicare terms 'eligibility' and 'entitlement' are not synonymous, and it is important to understand the difference. 'Entitlement' means that an individual who is eligible for Medicare has actually enrolled in Medicare and may currently receive benefits. An individual who must take additional steps to enroll in Medicare before receiving benefits is not yet 'entitled' to Medicare for purposes of the COBRA rules."  MORE >>

"The proposed rules clarify certain key issues in the ESST law, including employer administration of ESST benefits, determining hours worked that are subject to ESST accrual, an employee's right to use ESST, incentives related to production or attendance goals, reasonable documentation, employee misuse of ESST, and the interaction of employers' more generous paid leave policies with the ESST law.... There is a 30-day public comment period, with the effective date of these rules yet to be determined. "  MORE >>

"Beginning February 22, 2026, covered New York City employers must provide employees with an additional 32 hours of unpaid safe and sick time, frontloaded at hire.... The amended Earned Safe and Sick Time Act (ESSTA) adds four potential uses for safe and sick time ... Employers must also provide 20 hours of paid prenatal leave per 52-week period, which is concurrent with New York State law."  MORE >>

"Employees with covered family members serving in these newly recognized branches may now qualify for paid leave under the FAMLI program. This includes leave to care for a service member with a serious health condition resulting from active duty."  MORE >>

"[N]ew California laws often provide a sneak preview of what to expect from statehouses the following year.... [1] Prescription drugs ... [2] Preventive care.... [3] Paid leave.... [4] Abortion medication.... [5] Prior authorization.... [6] Fertility coverage.... [7] Insulin coverage. "  MORE >>

"[E]mployer-sponsored health plans will not be able to require employees to use -- or give them financial incentives to use -- pharmacies owned or controlled by their pharmacy benefit managers (PBM), but will stand to receive 100 percent of the rebates received by a PBM or an affiliated rebate aggregator. Illinois's 'Prescription Drug Affordability Act' will further impact employer plans by prohibiting PBMs from using 'spread pricing'[.]"  MORE >>

"While many plans contract with TPAs to provide election notices to qualified beneficiaries, TPAs rarely agree to serve as the plan administrator, so the employer typically remains liable for any failure to provide timely notices. Plan administrators using a TPA to send election notices should verify that the TPA will maintain adequate documentation of what was mailed and when and will agree to indemnify the employer for any failure to properly provide required notice." [Casillas-Guardiola v. Bayer Puerto Rico, Inc., No. 22-1167 (D. P.R. Sep. 30, 2025)]  MORE >>

"Under [the October 29] order, the state may not enforce the law's $10.68 dispensing fee for each prescription filled at retail pharmacies in Iowa for affected Wellmark plans. The injunction also extends to CVS Caremark, Wellmark's pharmacy benefit manager, for covered health plans and policies." [Wellmark v. Ommen, No. 25-0377 (S.D. Iowa Oct. 29, 2025)]  MORE >>

"[P]lan sponsors often make changes year to year, and those changes require additional administrative action on the sponsor's part.... For group health plans, it includes obligating those vendors to comply with HIPAA, ACA, and transparency. Before you sign the contract, ensure that the important compliance requirements a plan cannot perform alone are considered in the contract. And, at the end of the process, do not forget to amend internal documents and policies, as needed, to reflect the changes."  MORE >>

"[1] Choosing your contracting approach ... [2] Industry context: evolving models and oversight ... [3] Practical steps for plans."  MORE >>

244 pages. "Despite these therapies being highly cost-effective, their potential budget impact is large.... [F]ewer than 1% of eligible patients could be treated at current and assumed net prices before crossing the ICER budget impact threshold of $880,000,000 annually. This raises serious concerns about affordability."  MORE >>

"[I]ndividuals and businesses in the Lower Kuskokwim Regional Educational Attendance Area, Lower Yukon Regional Educational Attendance Area, and Northwest Arctic Borough affected by severe storms, flooding and remnants of Typhoon Halong that began on Oct. 8, 2025 ... now have until May 1, 2026, to file various federal individual and business tax returns and make tax payments."  MORE >>